citalopram CELEXA
Class: SSRIFDA Indications: MDD
Off-Label Use: Binge Eating Disorder, GAD, Vasomotor Symptoms Of Menopause, OCD, Pathological Gambling, Premature Ejaculation, Fibromyalgia, Agitation In Alzheimers Disease
Prescribing
Forms: 10, 20, 40mg tablet; 10mg/5mL po solnDose Range: 10-60 mg/day
Starting: Start at 20 mg qd, ↑ dose by 20 mg q3 weeks; efficacy with doses >40 mg has not been demonstrated in clinical trials and doses >40 mg not recommended due to risk of ↑ QT interval
Stopping: Gradually taper the dose to minimize the incidence of withdrawal symptoms and allow for the detection of re-emerging symptoms
Precautions
Contraindications: Concomitant use of MAOIs, patients with congenital long QT, Concomitant use in patients taking pimozideSerious Side Effects: Serotonin syndrome; ↑ risk of SI in children and young adults; may impair platelet aggregation; SIADH
Known Risk of TdP
Side Effects: sedation/somnolence, xerostomia, diarrhea, nausea, hyperhidrosis, anorgasmia, tremor
Pharmacodynamics
1° MOA: Selective serotonin reuptake inhibitorTarget: SERT
Pharmacokinetics
t½: 35 (23-45)° TMAX: 2-4°Substrate of: 3A4, 2C19; 2D6
Inhibits: 1A2, 2D6 (both weakly); Induces: ∅
Active Metabolites: ∅
DDIs
- - DO NOT CO-PRESCRIBE WITH MAOIs (need a 14-day washout period)
- - 3A4 & 2C19 inhibitors can ↑ serum levels
Misc
- - generally less side effects than its predecessors in SSRI class
- -
highest risk of QTc prolongation in its class; mean QTc prolongation at various doses
- 20mg: 8.5ms
- 40mg: 12.5ms
- 60mg: 18.5ms
- - consider ECG when prescribing doses >40 mg
- - most remit at doses ranging from 40-60mg
- - linear & dose-proportional pharmacokinetics
Special Populations
Category C—No ↑ risk of major congenital malformations (0.9% in exposed group vs. 2.6% in control). There is an ↑ risk of admission to neonatal ICU
RID 3-10.9%
Pharmacokinetics are altered (~30% ↓ clearance) in patients >60; max dose of 20 mg/day is recommended due to risk of QT prolongation
Moderate renal disease ↑'d t½ from 37° to 49°
Maximum dose 20 mg qd due to ↓ clearance & ↑ QT risk (avg t½ 83° in cirrhotic patients)
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